Yoga for Cancer Survivors

Vol. 19, No. 2 - June 2012

By Amy Speed-Andrews, PhD, MS, MA, CSCA, Research Associate & Kerry S. Courneya, PhD, Professor and Canada Research Chair in Physical Activity and Cancer; Faculty of Physical Education and Recreation, University of Alberta

Summary

In recent years, yoga has been gaining in popularity as a non-traditional form of physical activity that can help to relieve symptoms experienced by cancer survivors and improve their quality of life.

This article discusses different research findings which suggest that yoga is a feasible, acceptable and enjoyable method to foster physical activity in cancer survivors.

In the last five years, about 24.6 million people in the world have been diagnosed with cancer. With today’s increasing incidence of cancer – along with improvements in treatment and prognosis – it is anticipated that the number of cancer survivors will continue to grow.

Among the most common symptoms experienced by cancer patients are pain, anxiety, depression and fatigue. Such symptoms often appear during cancer treatment and persist after treatment ends. 

In recent years, yoga has been gaining in popularity as a non-traditional form of physical activity that can help to relieve symptoms experienced by cancer survivors and improve their quality of life. This article discusses different research findings which suggest that yoga is a feasible, acceptable and enjoyable method to foster physical activity in cancer survivors.

About Physical Activity During and After Cancer Treatment

Traditional medical management of common symptoms experienced by cancer patients typically involves pharmacological treatments, which often result in significant side effects of their own. 

A recent American College of Sports Medicine review concluded that physical activity is safe during and after cancer treatment (Schmitz et al., 2010). In addition, a growing body of research provides support for the benefits of physical activity in managing the side effects of treatment and the cancer experience (McMillan & Newhouse, 2011; Pekmezi & Demark-Wahnefried, 2011). 


Benefits of Yoga for Cancer Survivors

Our research team conducted a pilot evaluation of an existing 12-week Iyengar yoga program for breast cancer. The program uses a modified approach, including props and supports, allowing people at different fitness and ability levels to participate.

Our findings suggested that participation in Iyengar yoga can improve several dimensions of generic quality of life (QoL), including overall mental health, vitality, role-emotional, and bodily pain.  We also observed a trend in the positive direction for perceived stress, depression, body image, and self-esteem – from baseline to post-program (Speed-Andrews, Stevinson, Belanger, Mirus & Courneya, 2010).

A growing number of scientific studies have documented the benefits to cancer survivors from practicing yoga. Here are some other recent examples:

• Several small pilot and prospective intervention studies have suggested that yoga can reduce the stress and side effects of cancer treatment, including improvements in QoL, social functioning, as well as spiritual and emotional well-being (Culos-Reed, Carlson, Daroux & Hately-Aldous, 2006; Danhauer et al., 2009).
• Several recent systematic reviews have suggested that yoga for cancer survivors can lead to important health benefits.  Yoga groups in comparison to wait list controls showed significant improvement in psychological health, including anxiety, depression, distress and stress.  The results also indicate a trend toward a small positive effect of yoga on QoL (Smith & Pukall, 2009; Lin, Yu-Ting, King-Jen, Heui-Fin, & Jau-Yih, 2011).
• A recent clinical trial examined the use of yoga to improve symptom management among 410 early-stage cancer survivors.  The University of Rochester Medical Center’s YOCAS® program for cancer survivors demonstrated (Mustian et al., 2010) improvements in sleep, fatigue, and QoL after 4 weeks of yoga versus usual care.

Using Yoga to Target Specific Symptoms

Emerging research suggests that yoga may be beneficial for targeting specific symptoms experienced by cancer patients. Here are some research examples:

• Fatigue is an important problem for approximately one-third of cancer survivors. A study by Banasik, William, Haberman, Blank, S.E., & Bendel (2011) suggested that 8 weeks of participation in a 90-minute, twice-weekly Iyengar yoga class may reduce fatigue and decrease salivary cortisol secretion in breast cancer survivors.  Positive correlations have been reported between morning cortisol, anxiety and depression.
• Chemotherapy-related cognitive impairment or “chemobrain” is of significant concern to patients with cancer; estimates range from 17 to 75%.  Galantino et al. (2012) examined the impact of an Iyengar-inspired yoga program on measures of cognition, functional outcomes and QoL for breast cancer survivors.  They reported an impact from the yoga intervention during chemotherapy which affects cognition; specifically, reduction in errors and improvements in speed.
• Arthralgia (joint pain) is a major side effect for breast cancer survivors who receive aromatase inhibitors.  One particular concern is that patients are becoming non-compliant based on the pain they are experiencing.  A few small, short-term studies have indicated that yoga may relieve symptoms associated with aromatase inhibitors (Galantino et al., 2011; 2012). 

Conclusion

Research studies examining yoga as an effective adjunct therapy for cancer patients are still preliminary, yet promising.  Overall, findings suggest yoga is a feasible, acceptable, and enjoyable method to foster physical activity in cancer survivors and may also improve several dimensions of QoL. 

Key Terms

Cancer survivor: Includes people living with cancer and those who have had cancer in the past.

Cortisol: A hormone in the human body that is produced in higher levels during stress. If cortisol levels are too elevated over time, it can negatively affect health, such as impairing the immune system.

Symptom burden: The kinds of symptoms experienced by people living with cancer; among the most common symptoms are pain, anxiety, depression and fatigue, often appearing during cancer treatment and persisting after treatment ends.

About the Authors

Dr. Amy Speed-Andrews completed her post-doctoral fellowship in exercise oncology in 2010, under the supervision of Dr. Courneya. Her current research interests involve examining the benefits of yoga on quality of life outcomes and physical function in breast cancer survivors. She is currently the study coordinator for the Breast Cancer and Exercise Trial in Alberta.

Dr. Kerry S. Courneya is a Professor, Director of the Behavioural Medicine Laboratory, and holds a Canada Research Chair in Physical Activity and Cancer at the University of Alberta. His research program focuses on physical activity and cancer, including: primary prevention; coping with treatments, recovery after treatments; long term survivorship; and disease recurrence and survival.

References

Banasik, J., William, H., Haberman, M., Blank, S.E., & Bendel, R. (2011). Effect of Iyengar yoga practice on fatigue and diurnal salivary cortisol concentration in breast cancer survivors. Journal of the American Academy of Nurse Practitioners, 23, 135-42. doi: 10.1111/j.1745-7599.2010.00573.x

Culos-Reed, S.N., Carlson, L.E., Daroux, L.M. & Hately-Aldous, S.A. (2006).  A pilot study of yoga for breast cancer survivors: physical and psychological benefits.  Psychooncology, 15, 891-897.  doi: 10.1002/pon.1021

Danhauer, S.C., Mihalko, S.L., Russell, G.B., Campbell, G.R., Felder, L., Daley, K., & Levine, E.A. (2009).  Restorative yoga for women with breast cancer: findings from a randomized pilot study.  Psychooncology, 18, 360-368.  doi: 10.1002/pon.1503

Galantino, M.L., Desai, K., Greene, L., DeMichele, A., Tompkins Stricker, C. & Mao, J.J. (2011).   Impact of yoga on functional outcomes in breast cancer survivors with Aromatase Inhibitor associated arthralgias.  Integrative Cancer Therapies.  doi: 10.1177/1534735411413270. 

Galantino, M.L., Greene, L., Archetto, B., Baumgartner, M., Hassall, P., Murphy, J.K., Umstetter, J., & Desai, K. (2012). A qualitative exploration of the impact of yoga on breast cancer survivors with aromatase inhibitor-associated arthralgias. Explore: The Journal of Science and Healing, 81, 40-47.

Lin, K.Y., Yu-Ting, H., King-Jen, C., Heui-Fin, L. & Jau-Yih, T. (2011).  Effects of yoga on psychological health, quality of life, and physical health of patients with cancer: a meta-analysis.  Evidence-based Complementary and Alternative Medicine.  doi: 10.1155/2011/659876.

McMillan, E.M. & Newhouse, I.J. (2011).  Exercise is an effective treatment modality for reducing cancer-related fatigue and improving physical capacity in cancer patients and survivors: a meta-analysis.  Applied Physiology, Nutrition and Metabolism, 36, 892-903.  doi: 10.1139/H11-082.

Mustian, K.M., Palesh, O., Sprod, L., Peppone, L.J., Heckler, C.E., Morrow, G.R. (2010). Effect of YOCAS yoga on sleep, fatigue, and quality of life: A URCC CCOP randomized, controlled clinical trial among 410 cancer survivors. Journal of Clinical Oncology, 28:15s (suppl; abstr 9013).

Pekmezi, D.W. & Demark-Wahnefried, W. (2011). Updated evidence in support of diet and exercise interventions in cancer survivors.  Acta Oncologica, 50, 167-178. doi: 10.3109/0284186X.2010.529822

Schmitz, K.H., Courneya, K.S., Matthews, C., Demark-Wahnefried, W., Galvão, D.A., ... Schwartz, A.L. (2010).  American College of Sports Medicine roundtable on exercise guidelines for cancer survivors.  Medicine and Science in Sports and Exercise, 42, 195.

Smith, K.B. & Pukall, C.F. (2009).  An evidence-based review of yoga as a complementary intervention for patients with cancer.  Psychooncology, 18, 465-475. doi: 10.1002/pon.1411.

Speed-Andrews, A.E., Stevinson, C., Belanger, L.J., Mirus, J.J. & Courneya, K.S. (2010).  Pilot evaluation of an Iyengar Yoga program for breast cancer survivors.  Cancer Nursing, 33, 369-381.  doi:10.1097/NCC.0b013e3181cfb55a.